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Vol. ~ EINet News Briefs ~ Mar 21, 2008
*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
1. Influenza News
- Global: Cumulative number of human cases of avian influenza A/(H5N1)
- Global: Time to acknowledge social and economic effects of H5N1 avian influenza, experts say
- Turkey (Edirne): Backyard chickens infected with H5N1 avian influenza
- Hong Kong: Schools shut due to outbreaks of seasonal influenza
- Indonesia: H5N1 avian influenza and H3N2 seasonal influenza co-infection in Indonesian teenager
- Laos: Government officials report a new outbreak of H5N1 avian influenza in poultry
- Viet Nam (Quang Nam): H5N1 avian influenza outbreak in ducks
- USA: US has enough H5N1 avian influenza vaccine for 13 million people
- USA: New patch boosts immunity to H5N1 avian influenza
- China (Guangdong): Officials report H5N1 avian influenza outbreak in poultry
- Viet Nam: Vietnamese child dies from H5N1 avian influenza, country's 106th case/52nd death
2. Infectious Disease News
- Australia (New South Wales): Rise in mosquito-borne illnesses prompts bite warning
- Australia (Queensland): Measles outbreak spreads to mine workers
- Australia: Number of dengue fever cases rising in Port Douglas
- Philippines (Laguna, Iloilo): Typhoid outbreaks sicken thousands, deaths reported
- Thailand (Prachuap Khiri Khan): Economy reports first case of Tularemia
- Canada (Chilliwack): Health officials report five cases of lab-confirmed mumps
- Canada: Eight family members sickened by unknown illness
- USA: Experts closing in on heparin contaminant
- USA (Virginia): Imported case of measles worries U.S. health officials
- USA: Officials report three new cases of hantavirus
- USA (Arizona): Second case of measles confirmed at Northwest Medical Center
- USA (Nebraska): Progressive inflammatory neuropathy in pork plant worker
- AVIAN PANDEMIC INFLUENZA
- Indonesia (FAO report)
- A survey of knowledge, attitudes and practices towards avian influenza in an adult population of Italy
- A broadly protective vaccine against globally dispersed clade 1 and clade 2 H5N1 influenza viruses
- Current and future antiviral therapy of severe seasonal and avian influenza.
- The Southeast Asian Influenza Clinical Research Network: Development and challenges for a new multilateral research endeavor
- Ecology of H3 avian influenza viruses in Korea and assessment of their pathogenic potentials
- APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
- 13th International Congress on Infectious Diseases (ICID)
- HHS includes online services in pandemic communication drill
1. Influenza News
Global: Cumulative number of human cases of avian influenza A/(H5N1)
Economy / Cases (Deaths)
Total no. of confirmed human cases of avian influenza A/(H5N1), Dec 2003 to present: 373(236).
Avian influenza age distribution data from WHO/WPRO: http://www.wpro.who.int/sites/csr/data/data_Graphs.htm .
WHO's maps showing world's areas affected by H5N1 avian influenza (last updated 3.18.08):
WHO’s timeline of important H5N1-related events (last updated 3.11.07):
Global: Time to acknowledge social and economic effects of H5N1 avian influenza, experts say
H5N1's potential for causing a human pandemic has understandably been the major focus of research, the scientists acknowledged. But "for every human being infected, there is at least one million animals infected—and that is probably an underestimate," Dr. Ilaria Capua, the head of virology at Italy's Istituto Zooprofilattico Sperimentale delle Venezie, said. "The veterinary community . . . have never before faced a challenge this big."
The economic repercussions reach from the micro level of village markets to the macro level of national economies and back, said Dr. Alejandro Thiermann, special advisor to the director-general of the World Organization for Animal Health. Fearing the importation of H5N1 flu, some countries have banned imports of chicken produced in affected countries, even when the disease has been found in wild birds rather than poultry. The resulting collapse in trade within a country depresses the prices that small-scale growers earn and makes them less willing to report disease outbreaks. The problem has proved so significant that new provisions governing avian flu-related trade restrictions are being added to the Animal Terrestrial Code, an international treaty governing veterinary health, said Thiermann, who serves as the Code's secretary.
The adoption of widespread poultry vaccination, one of the chief tools for controlling avian flu, also illustrates the complexity of integrating flu control into cultures and economies, said Dr. Les Sims of Australia's Asia-Pacific Veterinary Information Services. Stringent vaccination has successfully controlled avian flu in Hong Kong since late 2003, Sims said, but Hong Kong is "small and rich" and its results have not been replicated in any other country where avian flu is endemic. "We knew that mass vaccination would be very difficult to sustain, both the financial cost to the government and the enthusiasm of the people to go out and support it," he said. "The problems that are occurring in Vietnam now are largely ones that appear to be due to farmers not having their birds vaccinated rather than to vaccine failure."
Successful avian flu control will require attention to these and other "last-mile" difficulties that are not usually the province of virologists or human-health planners, the scientists cautioned.
Turkey (Edirne): Backyard chickens infected with H5N1 avian influenza
Veterinary officials in Turkey have confirmed an H5N1 avian influenza outbreak in the western part of the country near the border with Greece, according to a report on 8 Mar 2008 from the World Organization for Animal Health (OIE). The virus struck 22 backyard chickens at a village near Ipsala in Edirne province. The remaining 16 birds were destroyed. Turkish officials listed fomites, which could involve contamination spread by humans, vehicles, or animal feed, as the source of the outbreak. Turkey's last H5N1 outbreaks occurred over several weeks in January and February 2008 at six sites, all of which involved backyard poultry.
All of the previous outbreaks occurred near villages along the Black Sea, an area that officials from the United Nations Food and Agriculture Organization (FAO) have said is vulnerable to H5N1 outbreaks, because surrounding countries are a winter home to migratory birds from Siberia and often have poor separation between wild and domestic birds. In contrast to previous outbreaks, the Ipsala area is close to the Mediterranean Sea.
Hong Kong: Schools shut due to outbreaks of seasonal influenza
Hong Kong's top health official announced on 12 Mar 2008 that all primary schools, special schools and kindergartens in the city would close for two weeks due to seasonal flu outbreaks. Dr. York Chow, secretary for Food and Health of Hong Kong Special Administrative Region (HKSAR) government made the announcement after the Department of Health and the Bureau of Education met to review the data of the flu and the response of parents.
"We made the decision given the rising trend of flu infections within the community as the flu peak is expected to continue for weeks," Chow said. "We hope such precautionary measures will help reduce the cross infection of the flu virus in schools and the community."
Chow said that an expert group was doing its best to investigate the recent deaths of three children with flu-like symptoms, adding that at this stage, no common factors have been identified. He said the most important thing at the moment is to grasp a clear picture of the outbreaks and whether they are spreading. On 12 March 2008, the Center for Health Protection (CHP) of the Department of Health (DH) received reports of influenza-like illness (ILI) outbreaks affecting 23 schools involving a total of 184 people. A CHP spokesman said ILI could be caused by influenza or other respiratory viruses. CHP's officials have visited all these institutions and provided health advice to the staff accordingly.
CHP received a report from Hospital Authority on 12 March 2008 concerning a three-year-old boy who was admitted to Princess Margaret Hospital because of persistent fever, cough, and shortness of breath. The boy was transferred to Intensive Care Unit and is now in stable condition, said the spokesman, adding that initial investigation showed his respiratory sample yielded positive results for influenza A (H1N1). Further tests are in progress. Regarding the death of a 7-year-old boy with respiratory and neurological symptoms in Tuen Mun Hospital, the spokesman said further laboratory tests showed that the boy's respiratory sample yielded positive results for influenza A (H1N1) (other reports maintain that it was a dual H1 and H3 infection). A three-year-old girl also died of the flu early this month, following the death of a two-year-old child at the end of February 2008. Hong Kong health officials have reported nine confirmed flu cases and 65 suspected ones since 6 Mar 2008, mostly at schools, in the territory of nearly seven million.
The Hospital Authority (HA) on 12 Mar 2008 announced that a special fund of 20 million HK dollars (2.6 million USD) had been set aside to implement a series of measures through April 2008 to cope with recent surge in demand for public hospital services due to seasonal influenza. Public hospitals have been experiencing a prolonged increase in emergency demand lately, in particular the emergency medical admissions, HA Chief Executive Shane Solomon said.
"Compared with February last year, the daily number of emergency medical admissions is 16 percent higher. At the same time, recent admission to pediatric wards in public hospitals has also surged," he said.
The sudden and unprecedented surge in demand in medical and pediatric wards has created great pressure on the front line staff. To cope with the recent surge, various hospital clusters have opened extra beds and implemented other initiatives to cope with patient needs.
Indonesia: H5N1 avian influenza and H3N2 seasonal influenza co-infection in Indonesian teenager
In a paper presented on Mon 17 Mar 2008 at the International Conference on Emerging Infectious Diseases, Vivi Setiawaty of Indonesia's Center for Biomedical and Pharmaceutical Research and Development described the case of a 16-year-old girl who was tested for flu in Jakarta in April 2007 under a flu-surveillance system established in 2005 by the Indonesian Ministry of Health.
The girl, who had been experiencing flu symptoms for several days, was only mildly ill, with a 100.5 F fever, sore throat, cough, headache, and body aches, but no difficulty breathing and no signs of pneumonia (case reports of H5N1 patients in countries such as Thailand have described more dramatic clinical presentations). Throat and nasal-swab samples that were taken on the sixth day of her symptoms tested positive by reverse-transcriptase polymerase chain reaction (RT-PCR) for both avian influenza H5N1 and the seasonal flu strain H3N2 at the Indonesian National Institute of Health Research and Development. Serology test results were less clear. Antibody titers from serum samples taken the sixth day provided a weak indication of H5N1 infection (titer of 1:10) but were negative for H3N2; convalescent sera, on the other hand, gave a strong indication of H3N2 infection (titer of 1:640) but were negative for H5N1. Eijkman Institute for Molecular Biology in Jakarta, an arm of the Indonesian Ministry of Research and Technology, confirmed the test results, according to the paper. The girl's case fell within the period when the Indonesian government was not sharing flu isolates with the international laboratory system maintained by the World Health Organization, and there was no indication whether her isolates were evaluated outside the country.
"This is the first case-report of a human with both influenza A/H5N1 and H3N2 co-infection," the paper states. "Such infections are of great concern due to the possibility of genetic re-assortment leading to the emergence of a H5N1 strain that is more easily transmitted human to human, and emphasizes the importance of advanced laboratory-based surveillance in geographic regions where both human and avian influenza viruses are co-circulating."
Laos: Government officials report a new outbreak of H5N1 avian influenza in poultry
Viet Nam (Quang Nam): H5N1 avian influenza outbreak in ducks
USA: US has enough H5N1 avian influenza vaccine for 13 million people
A progress report released on 20 March 2008 says the US government has stockpiled enough pre-pandemic H5N1 influenza vaccine for 13 million people, more than double the number listed in the previous report, issued in July 2007.
The report on pandemic preparations by the Department of Health and Human Services (HHS) also says the government plans to release a new version of its pandemic vaccine allocation plan, after considering comments at a series of recent meetings and forums. The 16-page report from HHS Secretary Mike Leavitt lists a wide range of HHS pandemic preparations. It emphasizes the agency's efforts to collaborate with other stakeholders in tackling problems like vaccine allocation and who should bear the burden of stockpiling supplies such as face masks, respirators, and antiviral drugs. The report also says that HHS has acquired enough antiviral drugs to treat 40 million people, or about 80 percent of the agency's goal of 50 million. Officials want the states to buy enough additional doses with the help of a 25 percent federal subsidy to treat another 31 million people.
The report also says HHS:
USA: New patch boosts immunity to H5N1 avian influenza
The so-called adjuvant patch, to be used with an injected vaccine, could help stretch the supply during a pandemic, the Maryland-based company said. Current approved vaccines against the H5N1 avian influenza virus require two doses to be fully effective.
Iomai is testing its adjuvant patch on 500 volunteers in a phase 1/2 trial looking at the safety and efficacy of the patch. The patch is applied after gently scraping the skin with a light sandpaper-like device. It is used to boost an H5N1 vaccine made by the Belgian drug company Solvay. When used with a single dose of the 45-microgram H5N1vaccine, 73 percent of those tested had what is considered a protective immune response. About 49 percent of those who got the vaccine alone, without a patch, had an immune response considered protective after the first dose.
"The prospect of being able to immunize during a pandemic with a single dose is very attractive," said Iomai's chief scientific officer Gregory Glenn, whose company got a $128 million grant from the National Institutes of Health to test the patch.
At least 16 companies are testing H5N1 vaccines but no one knows precisely what a pandemic strain of the virus would look like or how to formulate the best vaccine. Tests on the current vaccines suggest that people need bigger doses than with seasonal influenza. Global flu vaccine production capabilities are limited and if bigger doses are needed, that means fewer people could be vaccinated in a pandemic.
"A one-dose pandemic flu vaccine is a very important advance," Glenn said. "There is just almost no way to immunize twice in the face of a pandemic."
Keeping the right records and counting people to show up twice are both barriers, he said. Adjuvants are frequently used to boost vaccines and some of the experimental H5N1 vaccines include adjuvants in the formulation.
China (Guangdong): Officials report H5N1 avian influenza outbreak in poultry
Viet Nam: Vietnamese child dies from H5N1 avian influenza, country's 106th case/52nd death
In late February 2008, 10 birds out of a chicken flock raised by the boy's family fell ill and died gradually. Then, his family slaughtered some healthy chickens of the flock for meals. Relevant provincial agencies have disinfected and detoxified the affected area, and selected samples from fowls in the area for bird flu testing.
2. Infectious Disease News
Australia (New South Wales): Rise in mosquito-borne illnesses prompts bite warning
Health authorities are warning people to protect themselves against mosquito bites following a three-fold increase in mosquito-borne viruses in the first two months of 2008. There were 380 cases of Ross River virus in New South Wales (NSW) in January and February 2008, up from 78 for the same period last year. Barmah Forest virus cases almost doubled to 121 over the same period, and more are expected in March 2008 as the mosquito season peaks. Recent rainfall has been blamed for the explosion in mosquito numbers and cases of the viruses, which cause debilitating symptoms such as tiredness, sore and swollen joints, rashes, and fever.
The potentially fatal Murray Valley encephalitis virus (MVEV) has been detected in mosquitoes and chickens in Griffith, Leeton, and the Macquarie Marshes. In rare cases the virus can also be transmitted to humans by mosquitoes, causing permanent brain damage and death.
"There have been no human MVEV infection cases to date, however the monitoring program results means there may be the potential for people to become infected if bitten by a mosquito," said Mr. Jeremy McAnulty, NSW Health director of communicable diseases. He urged people traveling throughout the state over Easter to take precautions such as wearing insect repellent and loose clothing; and avoiding going outside around dusk and dawn particularly when fishing, camping, or bush walking.
Australia (Queensland): Measles outbreak spreads to mine workers
Tropical Population Health Network Medical Director Dr. Jeffrey Hanna said the shopping center was the only common link between the four infected students and the two miners. He said it showed how contagious the disease was. The discovery of the first four locally acquired cases of the disease in 11 years prompted urgent warnings from public health authorities for people to be on the lookout for measles symptoms.
Although none of the students—two girls and two boys aged between 12 and 15—had to be treated in hospital, Dr. Hanna said three were very sick. The bigger concern was that they had been highly mobile while at their most contagious, using public buses, visiting two of Cairns' biggest shopping centers, a large popular Cairns restaurant, a swimming carnival, and a large party in the Kuranda area. Dr. Hanna said the two miners had not interacted outside the mine site during this early stage.
Australia: Number of dengue fever cases rising in Port Douglas
In the center of Mossman, streets to the west of Front St, between Grogan and Harper St, have been declared a warning zone. In 2003, more than 30 people contracted dengue in the inner-Cairns suburb of Parramatta Park, and a 1997-98 outbreak struck down 500 people in the Cairns and Port Douglas area with dengue fever.
Philippines (Laguna, Iloilo): Typhoid outbreaks sicken thousands, deaths reported
In another outbreak (Laguna Province) contaminated water triggered the outbreak of typhoid fever that has downed nearly 2,000 people and killed a 14-year-old girl in Calamba City, health secretary Francisco Duque III said on 10 Mar 2008. Tests showed that the water supplied by the Calamba Water District contained the salmonella bacteria and did not have enough chlorine to kill the microbes, he said. Duque said the number of people with typhoid fever had gone down to 876 from a high of 1800, but the health department could not yet declare that the outbreak had been contained. The department said earlier it suspected that the city's reservoir had been contaminated, but officials of Calamba's water district on 10 Mar 2008 claimed that the city's water was safe for drinking.
Thailand (Prachuap Khiri Khan): Economy reports first case of Tularemia
Dr. Thawat said the woman, whose name was withheld, had kept a number of rabbits in her house and could have been infected by Francisella tularensis, the bacterium that causes the disease, probably through an aerosol of body secretions from her infected pets. Dr. Thawat dismissed concerns about an outbreak, saying that there is no threat of human-to-human transmission and that relatives of the dead, who live under the same roof, should not worry. Cancer might have made the woman too weak to fight the disease, he said.
The ministry is waiting for the results of another lab test from the United States to see if the rabbit fever is of strains A or B, which are more dangerous. The chief of the public health office in Prachuap Khiri Khan, Pipop Janesuthivejjakul, appeared unshaken by the news of the disease. He said the public should not panic over the news of the woman's death, which took place in Kui Buri district in October 2007. The provincial office knew of no other victims in the country.
Canada (Chilliwack): Health officials report five cases of lab-confirmed mumps
Fraser Health is reporting five lab-confirmed cases of mumps in Chilliwack, in the wake of larger outbreaks in Alberta.
"It's been coming at us from east to west," said Fraser Health Medical Health Officer Dr. Gillian Arsenault, who pointed to cases documented in Nova Scotia, and later Alberta. "Apparently some of those infected (in Chilliwack) had either direct or indirect contact with the Alberta connection. So for anyone planning to go to Alberta, now is a good time to get vaccinated."
The local cases are likely just the tip of the iceberg given the "sneaky" nature of the mumps virus, she said. The virus is spread by saliva, so a cough or sneeze can send it traveling through the air with fine mist droplets.
"When we have lab-confirmed cases, it means there are more cases we don't know about," said Dr. Arsenault. "The reason for that is roughly one-third of infected people display no symptoms at all. For them it's just like a rotten cold." Another third of sufferers will experience swollen glands, testicles, or some other physical clue, and the swelling always comes on the heels of the cold-like symptoms. An individual who's been exposed can be infected and not know it, she said. "It only takes one coughing infected person in an ER or waiting room to spread the virus."
Asked if she thought British Columbia's population was immune enough to stop an outbreak, "We don't know," she said. Small clusters of mumps cases have been reported in other communities over the past year, which didn't in fact turn into larger outbreaks of the virus. "We're hoping the same will happen here," said the health official. "We don't know how fast or how big this iceberg is, so it's a good time to get the word out. The more people know, the more likelihood it won't turn into a big outbreak." Mumps "very rarely" kill people, she said, but they can fall ill and feel awful.
A total of 399 cases were reported in Alberta between 1 Sep 2007 and 4 Mar 2008, with the majority of cases in the Chinook region of southern Alberta, and the rest in Calgary. There were also outbreaks in Nova Scotia. "It shows we're not completely immune," said Arsenault.
Canada: Eight family members sickened by unknown illness
"Whatever sickness they had, as soon as someone touched them, and caressed them, cuddled them, or comforted them, they got sick as well, within 20 minutes, half an hour."
The plane was diverted to Fort Lauderdale late on 4 Mar 2008, and the eight were transferred to hospital. They included the man's 14-year-old nephew, the only one who had complained of stomach problems, and one of his daughters, a paramedic who had been treating the others. All were released by the time the flight finally resumed and landed in Edmonton around 8:30 a.m. on 5 Mar 2008.
The families had all eaten at the same place on 4 Mar 2008. But the man said not everyone who ate at the restaurant got sick, and although some of the young adults had been drinking alcohol, his brother-in-law who doesn't drink was also ill. Greg Meyer, an airport spokesperson in Fort Lauderdale, Florida, said officials from the U.S. Centers for Disease Control interviewed everyone on board and determined the sick passengers were not suffering from any airborne illness. Jim Rudolph, a spokesperson at the Edmonton International Airport, said there were no further illnesses reported on the flight once it resumed.
USA: Experts closing in on heparin contaminant
In interviews, heparin experts in China and the United States, including a researcher involved in the inquiry, said that a chemically altered substance called over-sulfated chondroitin sulfate is probably the contaminant that the FDA says is linked to hundreds of allergic reactions and 19 deaths. Even so, researchers said they were not certain that the contaminant, constituting between five percent and 20 percent of the drug, is what is causing the allergic reactions nor do they know precisely how or when it was mixed into the active ingredient.
Chondroitin sulfate is a widely used supplement to treat joint pain. In its unaltered state, it does not have the blood-thinning properties found in the contaminant. But scientists and researchers say the act of changing the molecule gives the substance anti-coagulating properties. Scientists who have examined batches of the contaminated heparin distributed by Baxter International in the United States said in interviews that they suspected that the heparin-like molecule was intentionally mixed into the drug.
"A child could tell you it's counterfeiting," said Dr. Jawed Fareed, a professor of pathology and pharmacology at Loyola University Chicago, who has been studying batches of heparin since the problems with the drug were discovered. He was conducting his own investigation because he was concerned that the quality problems with heparin were far more widespread than acknowledged.
An American chemist, who asked not to be identified because he had signed a confidentiality agreement, said he and the FDA had looked at chondroitin sulfate as a possible contaminant because of its structural similarities with heparin.
"It is something that is a little bit different," said the chemist, "like a distant family relative you don't recognize. Once we have the exact fingerprint, we will try to figure out how it got into the product."
Zhang Tianmin, 80, a retired professor at the Shandong University School of Pharmaceutical Sciences, said counterfeiters would likely choose chondroitin sulfate or chitosan, from shellfish, as a base substance to create a heparin-like molecule, because both substances are cheap. But since neither has natural blood-thinning activity, counterfeiters would have to add something that does.
"Sulfate groups appear naturally in the heparin molecule," Mr. Zhang said, "but they can also be produced by chemical synthesis."
Baxter has recalled virtually all of its heparin products in the United States. There have been no new deaths since the recall, the FDA said. Dr. Fareed said it was too early to say whether the contaminant is causing the adverse reactions. A variety of reactions have been observed, including abdominal pain, hypotension (low blood pressure), a burning sensation, vomiting, diarrhea, rising temperature, and anaphylaxis, he said, "but one cannot link all of these to one substance."
"This is a deliberate act of chemically manipulating a heparin-like substance and mixing it with heparin to increase the yield," he added. But some batches of heparin containing the contaminant did not elicit adverse reactions, casting uncertainty on their root cause, Dr. Fareed said.
USA (Virginia): Imported case of measles worries U.S. health officials
USA: Officials report three new cases of hantavirus
Testing coordinated by the Colorado Department of Health and Environment has confirmed that a Kiowa County man who died in late February 2008 had contracted a hantavirus.
A young Louisiana man has been battling hantavirus since symptoms began in early February 2008. He has been taken off the ventilator and dialysis, and is off all pain medication and antibiotics. Doctors say he probably got it in a duck blind (a cover device for hunters) in his home state of Louisiana.
The often-deadly disease is transmitted through the urine, droppings or saliva of infected rodents—especially deer mice (Peromyscus maniculatus). People contract the disease by breathing in the dried particles infected with the virus. Early symptoms include fever and muscle aches, possibly with chills, headache, nausea, vomiting, diarrhea, abdominal pain, and cough. Symptoms develop within one to six weeks after exposure. There is no specific treatment for hantavirus, but health officials say the chances for recovery are better with early medical attention.
USA (Arizona): Second case of measles confirmed at Northwest Medical Center
USA (Nebraska): Progressive inflammatory neuropathy in pork plant worker
The newest case brings the total number of workers known to be affected to 14. Officials said that as the investigation continues to look into past workers at all three plants, they expect to find more cases. Those affected have reported fatigue, numbness, and tingling in their arms and legs with a wide range of severity. Some have recovered and returned to work, while others are severely disabled. Officials are calling the condition progressive inflammatory neuropathy, or PIN. Most of those affected worked at Quality Pork Processors in Austin, MN, where the condition was first recognized, and two have been identified in Indiana. Nebraska officials declined to say which plant employed the meatpacker, but the only plant in the state that uses the high compression system is owned by Hormel Foods, based in Austin.
AVIAN PANDEMIC INFLUENZA
(UN; WHO; FAO, OIE; CDC; Health Canada; CIDRAP; PAHO; USGS)
Indonesia (FAO report)
“The human mortality rate from bird flu in Indonesia is the highest in the world and there will be more human cases if we do not focus more on containing the disease at source in animals,” said FAO Chief Veterinary Officer Joseph Domenech. “I am deeply concerned that the high level of virus circulation in birds in the country could create conditions for the virus to mutate and to finally cause a human influenza pandemic. The avian influenza situation in Indonesia is grave—all international partners and national authorities need to step up their efforts for halting the spread of the disease in animals and making the fight against the virus a top priority.”
31 provinces affected
“Indonesia is facing an uphill battle against a virus that is difficult to contain. Major human and financial resources, stronger political commitment and strengthened coordination between the central, province, and district authorities are required to improve surveillance and control measures,” he said
“We have also observed that new H5N1 avian influenza virus strains have recently emerged creating the possibility that vaccines currently in use may not be fully protecting poultry against the disease. This issue is being addressed by the Indonesian Ministry of Agriculture with technical assistance from OFFLU (OIE/FAO Influenza Network of Laboratories) and funding provided by USAID and AusAID. Also required are more investigations and the development of better poultry vaccines,” Domenech said. “The major challenge is to immediately apply the main components of a successful national avian influenza control strategy, based on effective surveillance, emergency culling and compensation, vaccination, improved biosecurity, effective laboratory and quarantine procedures, and movement controls of poultry and poultry products.”
A survey of knowledge, attitudes and practices towards avian influenza in an adult population of Italy
Giuseppe G, Abbate R, et al. BMC Infectious Diseases. 2008;8:36. doi:10.1186/1471-2334-8-36
A broadly protective vaccine against globally dispersed clade 1 and clade 2 H5N1 influenza viruses
The Southeast Asian Influenza Clinical Research Network: Development and challenges for a new multilateral research endeavor
Ecology of H3 avian influenza viruses in Korea and assessment of their pathogenic potentials
APEC EINet Pandemic Influenza Preparedness Virtual Symposium: Partnerships and Continuity Planning for Critical Systems
APEC EINet is pleased to host a special videoconference on pandemic influenza preparedness. This videoconference is a follow-up to our first “virtual symposium”, which was conducted in January 2006 with great success (participating economies were Australia, Canada, China, Korea, Philippines, Singapore, Chinese Taipei, Thailand, USA, and Viet Nam). You can view a five-minute video clip of our previous virtual symposium at: http://depts.washington.edu/einet/symposium.html. Our upcoming videoconference will be held in late May 2008. It will take place during the evening hours of 29 May in the Americas and in the morning hours of 30 May in Asia, for approximately 3.5 hours. Our objective is to describe how private and public sectors in the APEC region can cooperate and work effectively to prepare for and respond to an influenza pandemic.
Through this videoconference, we hope to promote regional information sharing and collaboration to enhance pandemic preparedness. In order to improve preparedness regionally, it is vital to understand how each economy in the region is undertaking this task. In this process, EINet will:
Date: June 19-22 Location: Kuala Lumpur, Malaysia Venue: Kuala Lumpur Convention Center
The meeting in Kuala Lumpur hosted by the Ministry of Health, Malaysia will again welcome delegates from over 100 countries. The program will include plenary talks by world-renowned experts in the science of infectious diseases and important topics critically presented by international luminaries in the field. Moreover, there will be great opportunities to spend time with leaders in the field, exchange ideas, and develop collaborations with scientists from distinguished medical centers around the globe. All who are committed to the prevention and control of infections worldwide will find this a compelling meeting that should not be missed.
HHS includes online services in pandemic communication drill
The exercise was the second time HHS has reached out to blogs. In May 2007, the department featured posts from bloggers such as Michael Coston of Avian Flu Diary and Greg Dworkin, MD, of FluWiki in a five-week pandemic preparedness blog series. HHS Secretary Mike Leavitt hosts his own blog on the HHS Web site. He is the first cabinet secretary to use the online forum, according to HHS.
Bloggers were also included in a one-day leadership conference that HHS hosted to engage community leaders in talking about local preparedness efforts and seek input on how to tailor HHS's own resource materials. "We recognize that during a pandemic information could be life-saving. As more and more people turn to the Internet for information and news, blogs have emerged as an important and influential communications tool," HHS said in its invitation to attend the tabletop exercise.
Federal officials at the table included HHS Secretary Leavitt and representatives from the Centers for Disease Control and Prevention (CDC), Department of State, Department of Homeland Security, and the Coast Guard. Representatives from state health departments and healthcare facilities also took part in the exercise, because they will also be fielding questions from the media and online sources throughout an influenza pandemic, and especially at the beginning.
Details about the pandemic exercise were off the record, but the scenario featured intensified activity overseas that prompted the World Health Organization to raise its pandemic alert stage. The situation then progressed to one suspected H5N1 case in the United States, which led to dozens of cases in major cities on both coasts. At several points during the exercise, moderator Forrest Sawyer, a former news anchor with ABC and NBC, asked the news media and online outlets to predict what their headlines would be and what information they would need from HHS, CDC, and other agencies. During the exercise the communications officials from HHS floated the idea of "embedding" some of their staff in media organizations to ease access to official information during a pandemic. The agency also said its media access policies now treat reputable blogs and other reputable online services the same as traditional media organizations.
Stephanie Marshall, director of pandemic communications at HHS, said that because growing numbers of people are going to online sources for news and information, "It's important for the government to understand how best to work with bloggers and other online journalists to distribute information. The exercise and the insights offered by the participating bloggers will help us improve and refine our existing pandemic communications plan."